Heart disease, stroke, and other blood-vessel diseases remain the leading cause of death for Americans and people in many other Western nations. Advanced heart disease can result in debilitating fatigue, although it is usually intertwined with other serious health problems, such as obesity and chronic obstructive pulmonary disease. Yet the more immediate problem is this: widely prescribed drugs, particularly statin-class cholesterol lowering drugs such as Lipitor, are a major cause of fatigue, muscle damage and weakness, and pain—and can contribute to the overall disease burden. It’s time to set the record straight on cholesterol and heart disease risk and how statin drugs can negatively affect your heart health. A lack of energy—not increased cholesterol levels, as we’ve been led to believe—may be the real culprit in many heart diseases, especially heart failure, cardiomyopathy, and advanced heart disease. And energy can be replenished and increased naturally with the right nutrients.

THE FACTS ON CHOLESTEROL
The roots of cardiovascular diseases amount to a medical tangle, in large part because of so many contributing factors. Physicians routinely ignore the basic reasons why heart disease develops; namely, poor eating habits, obesity, and a lack of physical activity. Instead, they focus on symptomatic treatments, such as reducing cholesterol levels. Unfortunately, statins create an illusion of protection, while setting the stage for complacency and a panoply of short- and long-term side effects. Why bother eating healthier foods, losing weight, or exercising when a tiny pill will lower your cholesterol and supposedly solve everything? Nearly everyone has heard that elevated blood levels of cholesterol are a cause of heart disease. Elevated cholesterol is certainly a sign that something is awry, but the evidence that cholesterol itself causes coronary heart disease is flimsy at best. (Calcium forms part of the fatty deposits that form inarteries, but we are not exhorted to consume less calcium!) Most of the time, high cholesterol levels are nothing more than a modest indicator of risk, except in hereditary hypercholesterolemia. Half of all heart attacks occur in people with normal cholesterol levels, a fact that undermines the validity of high cholesterol levels as a way to predict a heart attack. If measuring and treating elevated cholesterol is a dead end, what is a better factor to measure? In the late 1990s, researchers at Harvard Medical School found convincing evidence that chronic low-grade inflammation, not cholesterol, was a primary cause of coronary artery disease. They developed a test for high-sensitivity C-reactive protein (hsCRP) to measure this type of inflammation. Researchers found that people with elevated hsCRP levels were more than four times as likely to have a heart attack—a
relationship far stronger than any risk associated with cholesterol. In a recent study of young men, doctors also found that high levels of hsCRP were also closely related to feelings of fatigue in people in their forties and fifties.

STATINS AND FATIGUE
Aside from lowering cholesterol levels when that’s not addressing the underlying issue, there are a variety of problems with statin drugs, one being fatigue. The link between statins and fatigue lies in how these drugs work. Statins lower cholesterol levels by inhibiting an enzyme, HMG-CoA reductase, which is needed for cholesterol production. Yet statins affect far more than cholesterol. All of the chemical reactions that depend on HMG-CoA reductase also get blocked by statins. For example,your body uses this enzyme to make CoQ10, a vitamin-like substance that plays a fundamental role in energy production. CoQ10 is needed to complete a key step in the mitochondria’s ability to produce cellular energy. The most common side effect of statins is myalgia, or muscle pain. By conventional medical estimates, myalgia and myopathy (muscle disease) develop in 10 percent of statin users, but the actual number is probably higher. In a recent study of 83 patients, more than half suffered statin-induced muscle damage, including people who had stopped taking the drugs. That same study also found that the blood test that doctors use to assess muscle damage from statins was essentially useless. According to some research, microscopic signs of muscle damage develop within days of taking statins. Often, the muscle weakness and damage remain after
a person stops taking statins.

THE HEART CONNECTION
Just as the muscles of our arms and legs can break down in response to statins, so can the heart itself. After all, the heart is nothing more than a very specialized muscle with
exceptional energy requirements. Cardiomyopathy (weakening of the heart muscle) and heart failure have nothing to do with cholesterol levels and blockages in blood vessels. Rather, they reflect a catastrophic loss of energy in the heart muscle, which reduces its
ability to pump blood. Talk with almost any cardiologist, and he or she will state that the prevalence of cardiomyopathy and heart failure has increased significantly during the last 15 or so years. Both cardiomyopathy and heart failure cause extreme fatigue, poor
circulation, and weakness after the slightest exertion.Although statins increase the risk of cardiomyopathy and heart failure, there are other reasons for the greater prevalence of these diseases. One is that CoQ10 is virtually absent in the modern diet. As recently as 50 years ago, people commonly consumed large amounts of CoQ10 in organ meats, such as fried liver, heart, and other giblets in turkey and chicken stuffing. These days, giblets are usually discarded. Because of the widespread consumption of junk foods since the 1950s, most diets in developed countries also lack appreciable amounts of the nutritional building blocks of CoQ10, so many people have difficulty making it on their own.

SUPPLEMENTS FOR THE HEART
CoQ10 supplements, however, when taken early enough and in sufficient amounts (typically in the range of 300 to 400 mg daily), can help stabilize or reverse cardiomyopathy, heart failure, and some other types of heart diseases. Beginning in the 1970s, Japanese physicians began to use CoQ10 to treat cardiomyopathy and other forms of heart disease. In the 1980s, the late Per Langsjoen, MD, of Tyler, Texas, directed the first US clinical trials of CoQ10 in the treatment of heart failure. Incredibly, CoQ10 can often eliminate the need for heart transplants by reducing the severity of cardiomyopathy and heart failure. Like CoQ10, many other nutrients that benefit the heart do so by increasing energy, so an energy supplement may be appropriate as well. Look for a formula that also contains L-carnitine, alpha-lipoic acid, and B-complex vitamins. Most of these ingredients directly affect the ability of the heart to maintain its energy levels and output. L-carnitine helps transport fats into mitochondria, where they are, in a manner of speaking, combusted for energy, much in the way that a fuel injector delivers gasoline into an automobile engine. Alpha-lipoic acid is an antioxidant that has many cell-protective benefits, and its principal function is to foster energy production in the mitochondria. B-complex vitamins play diverse roles in ourhealth and are essential for the production of energy. They also help to normalize homocysteine levels.Too much homocysteine, a byproduct of protein metabolism, can damage blood vessel walls, increasing the risk of heart disease.

ANTIOXIDANTS & RIBOSE
Antioxidant vitamins C and E can neutralize free radicals, which slows cell damage. Vitamin C plays a multitude of roles in health, but two of them directly affect energy levels. First, vitamin C is needed to make adrenaline and other stimulating neurotransmitters. Second, it is necessary for the body’s synthesis of L-carnitine. Vitamin E is found to have many benefits for the heart. It has anti-inflammatory properties and is also a mild anticoagulant, helping to reduce the risk of blood clots. Although antioxidant supplements seem to go in and out of favor about every 10 years, the totality of the research indicates that they are safe and do reduce the risk of disease. Finally, consider ribose to increase energy and support heart health. To make and recycle ATP, the chemical form of energy in the cells, your body needs to use chemicals called adenine nucleotides, whose production depends on ribose. Ribose supplements can maximize the mitochondria’s ability to make ATP in muscles, and ribose has been found helpful for people with heart failure. I suggest taking 1,000 to 2,000 mg of ribose daily. As with any other mitochondria-enhancing supplements, ribose works best if you combine it with a protein-rich diet and a little physical activity.